VCS Technology Virtual Summer School Repair Request Form 23-24
IF YOU ARE STAFF OR A TEACHER, PLEASE CLICK ON THIS LINK FOR THE REPAIR FORM: TEACHER AND STAFF REPAIR FORM  
Please fill out this form to request remote learning technology assistance (students only) . This is for VIRTUAL LEARNERS ONLY. If you are attending school in-person please see your school's IT Technician. Please note, fees may incur if parts need to be replaced. Examples would be cracked screens, broken keyboards, etc. Thank you! 
Sign in to Google to save your progress. Learn more
Email *
Are you attending school in-person? If yes, please see the building Tech instead of using this form. Thanks :) *
Student's First and Last name *
Device Barcode (either a white sticker on top that begins with 5885, 5887, 5881 or 5210. There may also be a red and white sticker on the bottom) *
Contact email *
Phone number *
Student's School *
Student ID Number *
Student Grade level *
Please briefly describe the issue.
Repairs will be at TJMS. Please bring the device and charger to the Main office up front, the tech will be waiting there at the designated time slot chosen below. *
By checking the box below, you agree to pay any possible charges for any part replacements due to misuse or any behavior that is outside the realm of normal, everyday use. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Valpo.k12.in.us. Report Abuse
Google Forms